Pelvic organ prolapse (POP) and overactive bladder (OAB) frequently coexist and substantially impair women’s quality of life. While prolapse repair may improve OAB symptoms by restoring pelvic anatomy and bladder outlet function, surgery may also unmask or be followed by de novo OAB. To date, the overall effect of POP repair on OAB outcomes remains incompletely defined.
The aim of this study was to systematically review and synthesize randomized controlled trial (RCT) data evaluating the effect of POP repair on OAB-related symptoms.

A PRISMA-compliant systematic review and meta-analysis of RCTs assessing OAB symptoms before and after POP surgery was conducted. Searches were performed in PubMed/MEDLINE, Embase, and the Cochrane Library. Random-effects meta-analyses were performed using pre–post comparisons, accounting for within-subject correlation with external correlation assumptions (0.3, 0.5, and 0.7). Statistical heterogeneity was assessed using the I² statistic.

Eight randomized controlled trials including 807 women undergoing POP repair were included. Questionnaire-based outcomes consistently demonstrated significant postoperative improvement in urinary and OAB-related symptoms. Pooled analysis of three trials showed a significant reduction in UDI-6 scores following surgery (mean change −17 points, 95% CI −19.90 to −14.54; p < 0.001; I² = 0%). OAB-specific instruments demonstrated direct symptom improvement, with pooled weighted mean reductions of −3.17 points on the ICIQ-OAB and −12.9 points on the OAB-V8. Broader urinary symptom and quality-of-life measures (UIQ, ICIQ-SF, PFIQ) also showed consistent postoperative improvement across studies. Among women with preoperative OAB, persistent symptoms were reported in 20.6% of cases across surgical approaches.

Five trials reported de novo OAB following prolapse repair. Overall, 40 of 807 participants developed de novo OAB, corresponding to an incidence of approximately 5% across the included studies. Meta-analysis demonstrated a significantly increased odds of postoperative de novo OAB (odds ratio [OR] 15.46, 95% CI 5.08–47.02; I² = 0%), with consistent results across sensitivity analyses. Subgroup analysis showed higher odds of de novo OAB after sacrocolpopexy/sacrohysteropexy compared with vaginal procedures (OR 5.10, 95% CI 1.56–16.71; p = 0.01; I² = 0%), alongside more frequent concomitant sling use in the sacrocolpopexy groups. Reporting of participant- or procedure-level factors associated with de novo OAB was limited and heterogeneous across trials.

POP surgical repair is associated with clinically meaningful improvement in preoperative OAB-related and urinary symptoms, as demonstrated across multiple validated outcome measures. Although de novo OAB was observed, events were infrequent and occurred in the context of heterogeneous definitions, outcome measures, and concomitant pelvic procedures. The increased odds observed in meta-analysis likely reflect low baseline event rates and differences in reporting rather than a substantial absolute clinical risk. The higher rates following sacrocolpopexy may be influenced by procedural factors or concomitant anti-incontinence interventions.

POP repair is associated with a predominantly favorable postoperative OAB symptom trajectory, with significant improvement in pre-existing symptoms and a low incidence of de novo OAB. De novo OAB following POP surgery remains incompletely characterized and warrants further investigation in well-designed studies using standardized outcome measures.